Today’s asbestos awareness means that the widespread, and ultimately, fatal role the deadly insulation fibres played in the lives of countless thousands of industrial workers is regularly pointed out whenever industrial disease is mentioned.

In cases where death was caused by an industrial disease, a Coroner may conclude that mesothelioma was probably a “key factor”. The verdict may sometimes also be given even if the unfortunate victim was suffering with other known diseases. It also often the case that a widow and close family members believe there is good evidence to show that the deceased was in regular contact with asbestos at a former workplace.

Asbestos exposure as a key factor

In one recent case, a 82 year old retired steelworker had suffered from a stroke, bladder cancer and various lung problems including chronic obstructive pulmonary disease (COPD). However, it was stated that the former fitter also had pleural plaques – a benign thickening on the lining of the lungs – and a tumour which had also developed on the lung. At the time of death, the victim was suffering from lung cancer.

The Coroner concluded that COPD was the primary cause of death and the tumour most likely to be mesothelioma. The presence of pleural plaques – a recognised sign of exposure to asbestos – meant that asbestos exposure as a key factor could not be ruled out. The daughter clearly recalls her father recounting stories of having to remove asbestos from the furnaces and, as in nearly all cases, working in clouds of asbestos “floating in the air”.

The deceased has also been a lifelong smoker of up to 40 cigarettes a day. Medical research has clearly established that cigarette smokers who are exposed to asbestos could be up to 90 times more likely to develop asbestos lung cancer, and at least twice as likely to develop mesothelioma.

A number of tests need to be performed

Extending life expectancy for victims of the fatal, incurable cancer is dependent upon the ability to detect asbestosis diseases as early as possible. A major problem has always been the long period of between 15 to 50 years that elapses from first asbestos exposure to the appearance of the disease. Often diagnosed at a very late stage, a victim may only have between 2 – 6 months to live, and in some cases, just a few weeks.

Recognising the symptoms of mesothelioma and confirming a diagnosis is not straightforward. A number of tests need to be performed to conclusively determine that the asbestos-related cancer is present. While there are several methods of diagnosis, including blood tests and CT / MRI image scanning, doctors rely on biopsies as the only way to positively identify cancerous cells.

Biopsy tissue sample

A biopsy is traditionally where the chest cavity is opened up and a tissue sample is removed from the affected area, which can then be directly analysed under a microscope. Advances in medical technology now allow alternatives to invasive surgery, which still enable a doctor to directly analysis affected tissue.

Camera-assisted surgery – commonly known as “keyhole surgery” – is less invasive as only a couple of small cuts need to be made. A small camera attached to a thin tube is inserted through a small incision in the stomach while another tool is used to remove part of the cancerous tumour tissue.

Non-invasive fluid sample

A non-invasive biopsy can also be performed. A fluid sample, which may have built up in the lungs, is removed instead of a tissue sample. The fluid is collected by a long, thin needle, which is inserted into the affected area. Another method is to insert a tube and siphon off the fluid, which is also used for pain relief when draining fluid from pleural effusions which build up in affected lung linings.

The extracted fluid sample is then examined by looking at the cancer cells in clusters, which can help determine if a patient has mesothelioma, as well as the type and stage the cancer has reached. However, the fluid analysis is slightly less reliable than the tissue analysis despite being easier to obtain and is less painful.

Patients with suspected pleural (lung lining) mesothelioma are more likely to undergo a keyhole type biopsy while those with suspected stomach mesothelioma will probably have a fluid sample removed by the long needle because of the difficulty in locating the affected tissue.

Three quarters of all malignant mesothelioma cases are known to affect the pleural cavity. Up to one in five victims will develop mesothelioma cancer in the linings of the stomach.